​- We are not very good at making the diagnosis…correct as initial diagnosis only 15-50%- Type A involves ascending aorta and requires immediate cardiothoracic surgeon, Type B does not.- CT Angio is the study of choice in stable patients- Normal CXR in 12% of patients. Abnormal findings include wide mediastinum, abnormal aortic contour, pleural effusion, and wall Ca+ displacement- If no clinically apparent aortic insufficiency or CHF, then treat first with labetalol/esmolol then nitroprusside.

1.The first key in assessing a patients with dizziness is to define the problem: dizziness is not a medical term, and vertigo is not a diagnosis.

2.If a patient has nystagmus, it is important to interpret and document the nystagmus in a clinically meaningful way which will support your diagnostic decision making.

3.To adequately test the cerebellum, all three of the following must be assessed: limb ataxia, truncal ataxia, and oculomotor control.

4.Correct patient selection is essential when performing the Dix-Hallpike maneuver or the Head Thrust Test. The only patients who are appropriate candidates for the Dix-Hallpike test are those with a history consistent with BPPV. Similarly, the only patients who are appropriate candidates for the head thrust test (and the HINTS exam) are those with acute vestibular syndrome.

5.If the patient has the constellation of signs and symptoms that comprise acute vestibular syndrome, perform the HINTS exam to attempt to distinguish central from peripheral causes

6.Recognize that brain CT rarely identifies early-stage cerebellar infarction. DWMRI is reasonably sensitive for detecting cerebellar infarction early, but it is less sensitive than appropriately performed oculomotor assessment.

Tuberculosis-Immediately isolate any patient that you believe may have TB, and document that you have done so!-Upper lobe pneumonia should always prompt further consideration of tuberculosis, screen with risk factors-Patients with TB often have multiple ED visits with active disease, risk factors are often overlooked in triage-Remember, PPD and IFN blood testing is for latent TB only and will not help you diagnose active TB-Involve infectious disease, ensure that the health department is involved in the patient's case

Elderly Falls - Missed Femoral Neck Fracture-95% due to falls, more than 300k admissions per year-One year mortality in those over 65: 12-37%-High risk of malunion, poor healing, and avascular necrosis if missed-Surgical repair is performed as soon as medically stable for procedure-Range all joints, low threshold to image-Before discharge, consider home/social factors-For a full reassessment, ambulate the patient personally or with the nurse to prevent missed injuries and assess feasibility of discharge

General 1. WCT algorithms do not work in the real life setting 2. Don’t pay attention to what others have said; you need to evaluate the ECG yourself 3. First question: is the WCT regular or irregular?

2. Consider SVT if QRS morphology resembles RBBB or LBBB a. Find an old ECG: are the QRS morphologies identical? b. If no old ECG available, prove SVT by giving IV adenosine c. “I think this is SVT” is not good enough!

﻿·Erections lasting more than 4 hours are a medical emergency.·Secondary to impaired contraction of corporal smooth muscle.·Immediate aspiration/irrigation and/or injection of phenylephrine are the mainstay of treatment.·Don’t be afraid to use a big needle.﻿

Myocarditis:- broad spectrum of disease, high level of suspicion is essential- myocarditis can mimic STEMI and Wellens syndrome among others- EKG, echo, and cardiac enzymes cannot rule in/out the diagnosis- No hesitation to consult Peds Cards

NAT:- no discrimination, occurs in all people groups- history, exam, and physical findings may raise suspicion for abuse. - must place child in gown.- make sure story matches up... loose ends must be tied